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New Zealand Guidelines For ADHD

New Zealand Guidelines For Attention-Deficit/Hyperactivity Disorder

Guidelines for the assessment and treatment of Attention-Deficit/Hyperactivity Disorder will help health professionals make good decisions when helping children with this condition.

The New Zealand Guidelines for the Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder were released by the Ministry of Health today and are primarily aimed at paediatricians, general practitioners, and child and adolescent psychiatrists. They will also be of considerable value to all other health professionals who work with children and to parents who want accurate information.

Child and Youth Health Chief Advisor Dr Pat Tuohy said he hoped the guidelines would lead to early recognition of ADHD and ensure all children and young people with ADHD receive appropriate treatment.

"When assessing and treating children with ADHD New Zealand's health professionals will now be able to refer to a consistent set of guidelines based on international evidence.

"Early recognition and good management of ADHD will enable children with ADHD to better participate in education, recreation and family life. The Guidelines are also expected to reduce the stigma associated with ADHD and its medical treatment."

Attention-Deficit/Hyperactivity Disorder is a biological disorder and may affect three to five out of every 100 school children between six and 14 years old. It is characterised by persistent overactivity, impulsiveness and inattention which significantly impacts on a child's life. If left untreated it can cause considerable stress for children, families and schools.

The guidelines cover clinical assessment, diagnostic criteria, ADHD questionnaires, methods of evaluation, treatment and information on support services. They are based on similar guidelines used in Australia and the United States and were developed by a multi disciplinary group using the best international studies and evidence available.

Dr Tuohy said the guidelines will assist health professionals with the assessment of children who present with any disruptive behaviour problems.

"Wherever possible health professionals should get information from the child, parents, caregivers and school personnel and use appropriate and specific questionnaires for ADHD. There should be observations of the child in more than one environment by various people before a diagnosis is made.

"The holistic and cultural needs of the child and family should also be taken into account. The assessment and treatment of any other disorders or common problems such as emotional and behavioural disorders and learning problems is also very important." The guidelines will also assist with decisions on the best treatment for children with ADHD.

"Studies show that a carefully executed regimen of medication is more effective than behavioural treatment alone. Whether combined treatment - medication and behavioural treatment - is more effective than medication alone is less clear," Dr Tuohy said.

"We accept there are widely differing opinions and approaches to the treatment of ADHD. These guidelines are based on the premise that health professionals have a responsibility to ensure children get the most effective treatment that can be offered for their condition. This has been determined by careful evaluation of the evidence from the studies available."

The 63-page book of guidelines has been sent to health professionals and is also available on the Ministry of Health website www.moh.govt.nz.

For more information contact: Hayley Brock Media Advisor (04) 496 2115 025 495 989 http://www.moh.govt.nz/media.html

Background

What is ADHD? Attention-Deficit/Hyperactivity Disorder is a biological disorder and may affect three to five out of every 100 school children between six and 14 years old. It is characterised by persistent overactivity, impulsiveness and inattention which significantly impacts on a child's life. This can lead to significant impairment across a range of settings.

What causes ADHD? Genetic causes are the most common. The impairment in ADHD is likely to be caused by a variety of neurological factors involving the activity in the frontal lobe of the brain where executive decisions are made.

Why do health professionals need guidelines for the treatment and assessment of ADHD? In 1998 and 1999 there was growing public interest and awareness of ADHD as a condition and stimulant medication as a treatment. The individual and societal costs of ADHD and the increasing prescription rate of Ritalin and other stimulant drugs was being questioned. The Ministry took heed of public demands for increased recognition and management of the condition and started the process which would lead to development of the guidelines.

Who was in the group that developed the New Zealand Guidelines? The group included child and adolescent psychiatrists, paediatricians, general practitioners, the Ministry of Education, and ADHD group support representatives. For a detailed list see the Guidelines.

What studies were consulted by the group putting the Guidelines together? ADHD is one of the most widely and well-researched conditions in childhood. The process for developing the Guidelines involved an analysis of recent evidence-based systematic reviews and consensus conferences from the United States of America and Australia. Previous work by Professor John Werry was also included.

Why did the guidelines take two years to develop? The guideline development process began with Medsafe but the need for broader expert involvement led to the project being transferred to the Ministry of Health's Personal Health Directorate. The first meeting of the multi disciplinary group charged with developing the guidelines was on June 18 1999 and at that stage it was unclear how long it would take. Developing guidelines is a complex process which usually takes one to two years. The process involved a number of drafts and extensive discussion by the reference group that developed the Guidelines.

What guidelines existed for health professionals before now? New Zealand health professionals have been able to consult a number of authoritative texts including Professor R A Barclay's book "Attention Deficit Disorder Handbook: A Handbook for Diagnosis and Treatment, and Professor Werry's book "A Practitioners Guide to Psychoactive Drugs for Children and Adolescents". Position statements from the American Academy of Paediatrics and Practice Parameters of the American Academy of Child and Adolescent Psychiatry were also consulted by health professionals.

What do the guidelines say about the prescription of Methylphenidate (Ritalin) and other stimulants? The guidelines say that as a general rule after a comprehensive mental health assessment and after the health professional has carried out all the principles described in the Guidelines, medication should be considered if appropriate. Methylphenidate and dexamphetamine are regarded as a first choice pharmacological agents in the treatment of ADHD. After the medication has been well stabilised there should be regular reviews of its continued and long-term use.

What do the guidelines say about other treatments like diet treatment? Dietary treatment is popular among many parents and some clinicians but clinical trials have not produced sufficient evidence to recommend its use. Where parents initiate this treatment themselves, the practitioner should ensure that it is undertaken as safely as possible and should refer the family to a dietician.

Are there side effects for the child where medication is prescribed? Studies evaluating adverse effects of medication suggest most side effects of methylphenidate and dexamphetamine are relatively mild, of short duration and respond to dosing or timing adjustments. There appear to be no long term serious effects.

What other elements of treatment would a child with ADHD benefit from? Careful and regular monitoring of treatment effects including side effects, annual specialist reviews, treatment of any coexisting problems, comprehensive care for families that caters to their particular needs, that is holistic and culturally appropriate, linking parents with local support groups and effective management in the education setting.

Ends


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